Irs Form W 4 by jzh39785

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									                         REQUEST FOR REISSUED IRS FORM W-2

PLEASE PRINT AND SEND OR FAX TO:
Snohomish County
3000 Rockefeller, MS 610                               PHONE: (425) 388-3401
Everett WA 98201                                         FAX: (425) 388-3744
ATTN: Finance

 Please reissue a WAGE AND TAX STATEMENT - FORM W-2 for the tax year(s):
Social Security No. (last 4 digits only) XXX-XX-
EMPLOYEE NAME:
Street Address:
City:                                                   State:            Zip Code:
Phone Number:

Delivery Method (select one):                   NOTE: If no selection is made we will mail
                                                the form to the address on file.
              Mail
           Pick up           Picture ID required to pick up.
      Sent to Dept           Department Name:

The FORM W-2 is requested for the following reason:
                       Never received
                            Misplaced or Destroyed
                            Social Security Number incorrect (see below)   *
                            Name incorrect (see below)   *
                            Other (explain)

*   If your Social Security Number or name is incorrect, we will need a copy of your
    Social Security card to verify the correct information.




                                                Signature

                                                Date
FOR PAYROLL DEPT USE ONLY:
Date request rec'd:                             Original W-2 remailed:
Processed by:                                   Duplicate W-2 reissued:



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